Aerosolized Colistin for the Treatment of Multidrug-resistant Acinetobacter baumannii Pneumonia: Experience in a Tertiary Care Hospital in Northern Taiwan

Background/PurposeVentilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) Acinetobacter baumannii in critically ill patients presents an emerging challenge to clinicians. Administration of aerosolized colistin as an adjunctive therapy is one therapeutic option mentioned in limited evidence-based studies. This study aimed to evaluate the effectiveness of adjunctive aerosolized colistin treatment for VAP due to MDR pathogens.MethodsWe retrospectively reviewed the medical records of patients who had received aerosolized colistin for treatment of VAP due to MDR A. baumannii in our hospital from August to December 2008.ResultsForty-five patients were enrolled in our study. The mean age was 71 ± 15 years. The mean Acute Physiological and Chronic Health Evaluation II (APACHE II) scores on the day of intensive care unit admission and on the first day of aerosolized colistin administration were 22.5 ± 6.7 and 18.9 ± 5.7, respectively. The mean duration of intensive care unit stay was 34 ± 16 days. The mean daily dosage of aerosolized colistin was 4.29 ± 0.82 million IU, and the mean duration of administration was 10.29 days. Seventeen patients (37.8%) had a favorable microbiological outcome and 26 (57.8%) showed a clinical response. Mortality due to all causes was 42.2%. No adverse effects related to inhaled colistin were recorded.ConclusionAerosolized colistin may be considered as an adjunct to intravenous treatments in patients with VAP due to colistin-susceptible MDR A. baumannii in critically ill patients

Hearing Loss in Patients with Nasopharyngeal Carcinoma after Chemotherapy and Radiation

In light of the possible adverse effects of radiation on hearing, we conducted a study to evaluate the long-term sensorineural hearing status following radiotherapy (RT) in patients suffering from nasopharyngeal carcinoma. Audiologic examinations were performed at regular intervals before and after RT. We also analyzed the effects of age, chemotherapy, pre-RT hearing status, and post-RT otitis media with effusion (OME) on post-RT hearing change. A total of 150 patients (261 ears) were enrolled in this study and followed up for a mean of 43.8 months. After RT, 8.9-28.8% of ears had at least a 10 dB loss in bone conduction threshold at speech frequency, which was defined as an average of hearing threshold at 0.5 kHz, 1 kHz, and 2 kHz, while the percentage was 18-34.2% at 4 kHz. Patient age was related to these changes at speech frequency, and the presence of post-RT OME was related to significant loss at both speech frequency and 4 kHz. Pre-RT hearing status and chemotherapy did not influence hearing change. To sum up, sensorineural hearing loss began as early as after completion of RT. Early changes may be transient, but the effect of radiation on hearing tended to be chronic and progressive

Clinical characteristics and treatment outcomes of patients with tubo-ovarian abscess at a tertiary care hospital in Northern Taiwan

Background/PurposeControversy exists regarding the need for surgical intervention in patients with tubo-ovarian abscess (TOA). This study was aimed at investigating the clinical characteristics and treatment outcomes in patients with TOA at a tertiary care hospital in Taiwan.MethodsThe medical records of 83 patients who presented at the hospital with TOA between January 1, 2006, and December 31, 2007, were retrospectively reviewed. Outcomes of patients who received medical treatment alone or underwent surgical intervention were analyzed using univariate and logistic regression analyses.ResultsAmong the 83 patients with TOA, 13 patients (15.7%) underwent surgical intervention, and 70 patients (84.3%) received medical treatment alone. Significant variables related to surgical treatment in the univariate analysis were length of stay (short vs. long; t = −2.267, p = 0.026), department of admission (emergency room vs. outpatient department; χ2 = 7.459, p = 0.006), number of live births (nulliparous vs. multiparous; χ2 = 18.202, p = 0.001), and C-reactive protein (CRP) level (high vs. low; t = −2.250, p = 0.028). Logistic regression analysis performed to determine influential factors for surgical treatment showed that the operation odds ratio of three to four live births versus no live births was 33.995 (p = 0.043) and that of two live births versus no live births was 13.598 (p = 0.026).ConclusionPatients with TOA who underwent surgery had a longer duration of hospitalization. Among the patients who underwent surgical intervention, those admitted to the emergency room had higher CRP levels and were more likely to be multiparous

Effect of end-stage renal disease on long-term survival after a first-ever mechanical ventilation: a population-based study

The 30-day, 6-month, and 1-, 2-, 5-, and 10-year survival rate differences in the ESRD Pos and ESRD Neg groups from the beginning. (DOCX 17 kb

Atypical Presentation of Spinal Epidural Abscess—Prolonged and Intractable Abdominal Pain

SummaryDespite advances in medicine, early diagnosis of spinal epidural abscess remains a challenge to clinicians. The most common symptoms of spinal epidural abscess include back pain, fever, and neuralgic deficits. However, spinal epidural abscess can also present with vague and nonspecific symptoms. In this case, a 68-year-old male had abdominal pain in the right upper quadrant lasting 3 weeks and was diagnosed with a gastric ulcer. After treatment, his symptoms did not resolve. Fever and back pain became evident as his disease progressed, followed by right lower limb weakness and the inability to walk. He was taken to the emergency department of our hospital, and the weakness of his lower extremities worsened during hospitalization. His right leg became completely paralyzed despite the use of intravenous antibiotics. A spinal computed tomography scan was performed emergently (magnetic resonance imaging was unavailable) and revealed an epidural abscess involving T5–6 with adjacent osteomyelitis. The patient underwent posterior decompressive laminectomy with pus drainage in the T4–7 region. His neuralgic examinations improved soon after the operation, but ambulation remained limited. Early diagnosis is crucial to the prognosis of spinal epidural abscess, because delayed diagnosis usually results in complete paralysis even death. Thus, clinicians should be aware of atypical presentations of spinal epidural abscess

Study of sponge gourd ascorbate peroxidase and winter squash superoxide dismutase under respective flooding and chilling stresses

AbstractThe objectives of this work were to study the responses of ascorbate peroxidase (APX), catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GR), and physiological parameters of bitter melon (BM), sponge gourd (SG), and winter squash (WS) under waterlogged and low temperature conditions. The BM and SG plants were subjected to 0–72h flooding treatments. Moreover, BM and WS plants were exposed to chilling at 12/7°C (day/night) for 0–72h. The results show that different genotypes responded differently to environmental stress according to their various antioxidant enzymes and physiological parameters. The activity of APX in roots and leaves of SG plants significantly higher than that of BM plants during continuous flooding. Significant increases in SOD activity in leaves of WS plants were also observed throughout the entire chilling duration compared to BM plants. On the basis of our observations, we conclude that increased APX and SOD activities provide SG and WS plants with increased waterlogging and chilling stress tolerance, respectively. Both APX and SOD activities can be used for selecting BM lines with the best tolerances to water logging and chilling stresses